Published on April 27, 2014
A poison is any substance that causes harm if it gets into the body. . Almost any chemical can be a poison if there is enough in the body.
The amount of a chemical substance that gets into the body at one time is called the dose.
Depends upon availability and culture Uk –paracetamol is a problem Srilanka –pesticides South india –copper sulphate
Acute exposure Chronic exposure
Through mouth by swallowing Through lungs by breathing Contact Through skin Injection through skin
Most common route Children are commonly involved Can be accidental or deliberate Eg. Pesticide poisoning
Gas, vapour, dust Fine spray or droplet Poison enters to lungs and then spread across the whole body Eg. carbon monoxide
chemical is sprayed or splashed onto the skin if they wear clothes soaked with chemical. E.g. pesticide
Poisons can be injected through the skin from a syringe or a pressure gun During tattooing The bite or sting of a poisonous animal, insect, fish or snake.
DRUGS ,OTHER CHEMICALS Ethylene glycol Methanol Amphetamine Anticonvulsants Corrosives Anti diabetic drugs Antimalarials Batteries Benzodiazepines
Calcium channel blockers Insecticide Carbon monoxide Cocaine Cyanide Digoxin House hold products Nail polish Heavy metal poisoning Organophosphorous poisoning
Antidepressants Acetaminophen NSAID Antipsychotics Methyl xanthine Theophylline Snakes
Ethylene glycol is a sweet-tasting substance that is a common constituent of antifreeze.
The clinical course of ethylene glycol intoxication can be divided into three phases The first phase The first phase occurs less than 1 h after ingestion and is characterized by mental status depression, similar to that of alcohol intoxication ,coma ,seizurs, and respiratory depression
Second phase Cardio pulmonary toxicity Acidosis ,heart failure and pulmonary oedema Final stage Flank pain Acute tubular necrosis Hypocalcaemia Renal toxicity due to calcium oxalate
Air way support Circulatory support Correction of metabolic abnormalities Control of seizures Bicarbonate to correct acidosis Fomepizole is the new antidote by FDA Haemodialysis
Industrial alcohol Toxic alcohol Used in antifreeze,paint,thinner rubbing alcohol
Oxidised to formaldehyde then to formate Formate produces toxic effect and acidosis
Cns depression Head ache Lethargy Convulsions Delirium Coma Ocular symptoms Photophobia Central scotoma (loss of central vision ) Visual field defects Fixed pupils
Difficuilty in light adaptation Optic disc oedema Optic atrophy Other symptoms Nausea ,vomiting ,diaphoresis ,abdominal pain (due to pancreatitis)
airway protec-tion circulatory support correction of metabolic abnorm-alities control of seizures. ethanol and fomepizole for specific treatment Hemodialysis
commonly known as ecstasy drug or party drug, has been abused world-wide. Amphetamines are CNS and cardiovascular stimulants
Euphoria, extrovert behavior, lack of desire to eat or sleep, tremor, dilated pupils, tachycardia and hypertension Severe intoxication Agitation, paranoid delusions, hallucinations and violent behavior. Convulsions, rhabdomyolysis, hyperthermia and cardiac arrhythmias Intracerebral and subarachnoid Hemorrhage(rare)
Base line support Agitation is controlled by diazepam 10-20 mg i.v. chlorpromazine 50-100 mg i.m. injection
Carbamazepine. Phenytoin. Sodium valproate. Gabapentin. Lamotrigine Topiramaie
Drowsiness, respiratory depression,loss of consciousness, moclonic jerks, seizurs Lethargy, ataxia, slurred speech, nystagmus Posturing, agitation ,hallucinations
charcoal 50-100 g oral Hemodialysis
Corrosive agents: Acids: hydrochloric acid, sulfuric acid, hydrofluoric acid Alkali: sodium hydroxide, potassium hydroxide, ammonia, sodium hypochlorite Other: zinc chloride, mercuric chloride,, phenols, potassium permanganate, button batteries
Do not put NGT Acid exposure is life threatening Maintain ABC Specific antidots given to nutralise acid or alkali Sodium bi carbonate in acid poisoning Soda ,lemon juice ammonia in alkali poisoning
drowsiness, coma, twitching, convulsion depressed limb reflexes,apnea, pulmonary oedema, tachycardia and hypoglycemia
Ensure plasma glucose concentration Intra venous glucose Glucogon is also used Maintatanance with continuous glucose infusion with kcl
Hypotension acute heart failure, pulmonary oedema and cardiac arrest. Agitation and acute psychosis, convulsions and coma Brady arrhythmias and tachyarrhythmia's are common and ECG conduction abnormalities are similar to those seen in quinine poisoning (QT prolongation) tinnitus, deafness, vertigo, nausea, headache and diarrhea
Common suicidal agents Rarely produce severe poisoning Mostly in elderly with respiratory disease
drowsiness, ataxia, dysarthria nystagmus. Coma respiratory depression
Respiratory depression is managed by Airway support Flumanezenil 0.5-1.0 mg iv is the drug of choice
act by blocking voltage-gated calcium channels, Overdose of these drugs, particularly with verapamil and diltiazem, are serious with heart block and hypotension causing a significant fatality rate.
Hypotension Myocardial depression Conduction block Sinus bradycardia Heart block Pulmonary oedema Nausea Vomiting Seizures Lactic acidosis
Activated charcoal Intravenous hypotension with intravenous crystalloid Iv glucagon Dopamine to treat hypotension
Carbonate insecticides inhibit acetyl cholinesterase this effect is comparatively short-lived,and milder similar to Organophosphorous poisoning Atropine is the drug of choice
The commonest source of carbon monoxide is an improperly maintained and poor, ventilated heating system. The affinity of hemoglobin for carbon monoxide is some 240 times greater than that for oxygen. Carbon monoxide combines with hemoglobin to form carboxyhaemoglobin
Symptoms of mild to moderate exposure to carbon monox-ide may be mistaken for a viral illness In headache and mild exertional dyspnoea Higher concentrations of COHB are associated with coma, convulsions and cardio respiratory arrest
High flow oxygen Et intubation and mechanical ventillation
Assess airway and breathing Intubations Primary intervention Oxygen administration Intubation Subsequent assessment History,determine, LOC ,asses complaints Vital signs , look for rales or wheezes
Cocaine hydrochloride ('street' cocaine, 'coke') is a water-soluble powder or granule that can be taken orally, intrave-nously or intranasally.
Initial euphoria, agitation, tachycardia, hypertension, sweating, hallucinations, convulsions ,metabolic acidosis, hyperthermia, rhabdomyolysis, ventricular arrhythmias. Dissection of the aorta, Myocarditis, myocardial infarction, dilated cardiomyopathy, subarachnoid Hemorrhage, and cerebral Hemorrhage
Diazepam 10 mg iv to control agitation Active cooling Phentolamine 2-5 mg iv for hypertension
Primary assessment and interventions Subsequent assessment General interventions
Cyanide reversibly inhibits cytochrome oxidase a3 so that cellular respiration ceases. Cyanide and its derivatives are used widely in industry
Chest tightness Dyspnoea Coma Convulsion Metabolic acidosis
Support ABC Dicobalt edetate Sodium thiosulphate hydroxocobalamin
Toxicity occurring during chronic administration is common, though acute poisoning is infrequent
nausea, vomiting, dizziness, anorexia and drowsiness. Rarely, confusion, visual disturbances and hallucinations SVT with or without heart block VPC hyperkalemia
Atropine Digoxin –fab –specific antibody to neutralise Digoxin
bleach, cosmetics, toiletries, detergents, disinfectants and petroleum distillate Management Symptomatic
Arsenic Mercury Cadmium Iron Aluminium Lead
Arsenic is the most common cause of acute heavy metal poisoning in adults
Symptoms of acute exposure are cough, sore throat, and shortness of breath; metallic taste in the mouth, abdominal pain, nausea, vomiting and diarrhea; headaches, weakness, visual disturbances, tachycardia, and hypertension.
It is used in nickel-cadmium batteries chronic exposure could include alopecia, anemia, arthritis, learning disorders, migraines, growth impairment, emphysema, osteoporosis, loss of taste and smell, poor appetite, and cardiovascular disease
most of the toxic effects of iron occurs because iron is absorbed rapidly in the gastrointestinal tractMost overdoses appear to be the result of children mistaking red- coated ferrous sulfate tablets or adult multivitamin preparations for candy
Although aluminum is not a heavy metal Symptoms of aluminum toxicity include memory loss, learning difficulty, loss of coordination, disorientation, mental confusion, colic, heartburn, flatulence, and headaches
Lead accounts for most of the cases of pediatric heavy metal poisoning. It is a very soft metal and was used in pipes, drains, and soldering materials for many years. Target organs are the bones, brain, blood, kidneys, and thyroid gland exposure to lead occurs occupationally
abdominal pain-vomiting, constipation and encephalopathy (seizures, delir-ium, and coma) may develop in more severe cases.
chelation therapy sodium calcium acetate 75 mg/kg/day has been the chelating agent of choice
Organophosphorous insecticides are used widely throughout the world and are a common cause of poisoning, causing thousands of deaths, in the developing world
anxiety, restlessness, tired-ness, headache, and muscarinic features such as nausea, vomiting, abdominal colic, diarrhoea, tenesmus, sweating, hypersalivation and chest tightness. intermediate syndrome
Support ABC Gastric lavage Activated charcol Atropine 2 mg i.v. Should be given to reduce pulmonary oedema
Tricyclic antidepressants (TCAS) are potentially lethal in overdose. TCA agents act on multiple receptor sites. Their principal antidepressant action is mediated by serotonin and noradrenalin re-uptake inhibition.
Anticholinergic effects Agitation, delirium Dilated pupils Dry, warm, flushed skin Tachycardia Urinary retention Neurotoxicity Sedation Seizures Coma
Cardiotoxicity Tachycardia Hypotension Broad complex arrhythmias Bradycardia (late) Ecg changes Prolonged pr, qrs and qt interval
Within a few hours of acetaminophen overdose, typical symptoms include nausea and vomiting. Tenderness and pain in the upper right abdomen may be present. Very large doses can result in lactic acidosis (a drop in pH of the blood) and coma
NSAID use is associated with significant adverse effects such as gastrointestinal bleeding, peptic ulcer disease, high blood pressure, edema (i.e., swelling), and kidney disease
combine with gastro protective agents H2 receptor antagonist Ppi inhibiters Nutritional Support Antioxidents
Dopamine receptors Serotonin receptors Muscarinic receptors Alpha adrenargic receptors Histamine receptors
The methylxanthines theobromine and caffeine can be found in a variety of substances (e.g., chocolate, cocoaand coffee beans, over-the-countersleep prevention aids, asthma medications [theophylline, aminophylline]).
vomiting, diarrhea, polyuria, polydipsia, hyperactivity, ataxia, tachycardia,tachypnea, hypertension, weakness,cardiac arrhythmias, tremors, seizures,coma, and death
Emesis Activated charcol Supportive management
Theophylline has been widely prescribed for the management of patients with chronic obstructive lung disease and asthma. Despite declining use over recent years,
Agitation, hyperventilation, headache, convulsions Arrhythmiasnausea & vomiting (may be intractable), thirst, diarrhoea
Asymptomatic Charcoal 1g/kg Observe 4 hours. If no symptoms, discharge if not slow release medication .If ingestion of slow release preparation, admit for observation and serial drug levels
Symptomatic Charcoal 1g/kg initially unless altered conscious state (protect airway first) then 0.5g/kg 4 hourly, and whole bowel irrigation with colonic lavage solution 30ml/kg/hr.Cardiac monitoringI.V. fluid resuscitation & maintenance of adequate hydration is vital if depressed conscious state, arrhythmias or intractable vomiting may need intubation
Features Likely poisons Constricted pupils(miosis) Opioids, organophosphorus insecticides, nerve agents dilated pupils (mydriasis) Tricyclic antidepressants, amfetamines, cocaine, antimuscarinic drugs Divergent strabismus Tricyclic antidepressants Nystagmus Carbamazepine, phenytoin Loss of vision Methanol, quinine Papilledema Carbon monoxide, methanol Convulsions Tricyclic antidepressants, theophylline, opioids, mefenamic acid, isoniazid, amfetamines
Features Likely poisons Dystonic reactions Metoclopramide, phenothiazines Delirium and hallucinations Amfetamines, antimuscarinic drugs, cannabis, recovery from tricyclic antidepressant poisoning Hypertonia and hyper reflexia Tricyclic anti depressants Tinitus and deafness Salicilates Hyperthermia Salicilates ecstasy drugs
. POISON ABSORPTION Gut decontamination Gastric lavage.. Induce vomiting Single-dose activated charcoal Cathartics Whole bowel irrigation
Muiti-dose activated charcoal (mdac) Urine alkainization. Hemodialysis
Poison Antidote Aluminum (aluminum) Desferrioxamine (deferoxamine) Arsenic Dmsa,(dimercaptosuccinic acid) Benzodiazepines Flumazenil Beta -adrenoceptor blocking drugs Atropine, glucagon Calcium channel blockers Atropine Carbamate insecticides Atropine carbon monoxide Oxygen Copper D-penicillamine, dmps1
Poison Antidote Opioids Naloxone Organophosphorus insecticides atropine, hi-6, obidoxime,pralidoxime paracetamol (n-acetylcysteine) Thallium Berlin (prussian) blue Warfarin and other anticoagulants Phytomenadione (vitamin k)
Poisoning, Toxicology, Environmental Health. Air Pollution; Arsenic; Asbestos; Asbestosis see Asbestos; Biodefense and Bioterrorism; Biological Weapons see ...
Toxicology (from the Ancient Greek words ... mechanisms, treatments and detection of venoms and toxins; especially the poisoning of people.
Paracelsus (1493–1541), the father of toxicology, ... Acute poisoning is exposure to a poison on one occasion or during a short period of time.
Toxicology, Poisoning, and Teratogenicity Organizations. The American Association of Poison Control Centers (AAPCC) is a non-profit, national organization ...
Toxicology & Poisoning. Medical Toxicology at Yale New Haven Children's provides emergency and elective consultations for children and adolescents with ...
Becoming a Toxicologist. There are a number of degree and education paths that can lead an individual to a career in toxicology. ... poisoning are examples ...
Toxicology, an international journal, publishes only the highest quality original research and critical reviews dealing with the adverse effects of...
The National Toxicology Program (NTP) has been conducting experiments in rats and mice on potential health hazards from cell phone radiofrequency radiation.
A poison is any substance that is harmful to your body. The effects of poisoning range from short-term illness to brain damage, coma, and death.
There are many poisoning risks, including food poisoning, sun poisoning, alcohol poisoning, carbon monoxide poisoning, lead poisoning, and mercury poisoning.